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Background <p>Accurate vertebral numbering on lumbar MRI is complicated by transitional vertebrae, risking wrong-level surgery when whole-spine imaging is unavailable. This study aimed to identify the most reliable anatomical landmark for vertebral numbering in lumbar MRI-only settings by comparing four references (last rib, upper psoas muscle, iliolumbar ligament, and first fused vertebra) across normal and transitional anatomies.</p> Methods <p>This retrospective study analyzed whole-spine MRI scans from 444 asymptomatic adults undergoing health screening. For each subject, the vertebral levels of the four landmarks were recorded on whole-spine MRI, and the most frequently observed vertebral level for each was defined as its standard reference position. These positions were then retrospectively applied to the lumbar-only portion of the same dataset, with cervical and thoracic images intentionally excluded, to assess their reliability in a simulated lumbar MRI-only scenario.</p> Results <p>The upper end of the psoas muscle exhibited the highest correct identification rate (95.2%), followed by the last rib (93.5%), iliolumbar ligament (92.6%), and first fused vertebra (90.4%). The non-overlapping 95% CIs indicated a significant difference only between the psoas and the first fused vertebra; no significant differences were observed among the other three landmarks due to overlapping CIs.</p> Conclusions <p>The upper psoas muscle is a reliable landmark for lumbar MRI vertebral numbering, showing comparable accuracy to the last rib and iliolumbar ligament. It can serve as a practical tool to support accurate numbering in routine clinical practice.</p>

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Psoas muscle landmark as a reliable tool for vertebral numbering on lumbar magnetic resonance imaging: a retrospective study using whole-spine magnetic resonance imaging

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  • 发表日期：

    2026年7月29日

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  • Po-Shen Chen,
  • Howard Haw-Chang Lan,
  • Tsung-Fang Cheng,
  • Jen-I. Hwang,
  • Cheng-Chun Lee,
  • Yu-Chen Chen,
  • Wei-Jen Chang,
  • Ya-Lin Pao

摘要

Background

Accurate vertebral numbering on lumbar MRI is complicated by transitional vertebrae, risking wrong-level surgery when whole-spine imaging is unavailable. This study aimed to identify the most reliable anatomical landmark for vertebral numbering in lumbar MRI-only settings by comparing four references (last rib, upper psoas muscle, iliolumbar ligament, and first fused vertebra) across normal and transitional anatomies.

Methods

This retrospective study analyzed whole-spine MRI scans from 444 asymptomatic adults undergoing health screening. For each subject, the vertebral levels of the four landmarks were recorded on whole-spine MRI, and the most frequently observed vertebral level for each was defined as its standard reference position. These positions were then retrospectively applied to the lumbar-only portion of the same dataset, with cervical and thoracic images intentionally excluded, to assess their reliability in a simulated lumbar MRI-only scenario.

Results

The upper end of the psoas muscle exhibited the highest correct identification rate (95.2%), followed by the last rib (93.5%), iliolumbar ligament (92.6%), and first fused vertebra (90.4%). The non-overlapping 95% CIs indicated a significant difference only between the psoas and the first fused vertebra; no significant differences were observed among the other three landmarks due to overlapping CIs.

Conclusions

The upper psoas muscle is a reliable landmark for lumbar MRI vertebral numbering, showing comparable accuracy to the last rib and iliolumbar ligament. It can serve as a practical tool to support accurate numbering in routine clinical practice.